US20170181719A1 - Method and device for recording medical images - Google Patents
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- US20170181719A1 US20170181719A1 US15/115,921 US201515115921A US2017181719A1 US 20170181719 A1 US20170181719 A1 US 20170181719A1 US 201515115921 A US201515115921 A US 201515115921A US 2017181719 A1 US2017181719 A1 US 2017181719A1
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- A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
- A61B6/504—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of blood vessels, e.g. by angiography
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Definitions
- An embodiment of invention generally relates to a method and/or to an apparatus for capturing medical images, in particular via computed tomography (CT) or magnetic resonance imaging (MRI).
- CT computed tomography
- MRI magnetic resonance imaging
- an embodiment of the invention relates to capturing two-dimensional or three-dimensional images of the inside of a human body or of the body of an animal, which images are meant to show or display blood vessels in particular.
- Contrast agents like the radiation dose, have a potentially harmful effect on the patient, which is why it makes sense to keep levels to a minimum. Cost is also a factor when using a contrast agent, and therefore reducing the amount of contrast agent is also advantageous financially to organizations that operate imaging systems.
- the contrast agent is usually injected on the basis of a protocol, which is specified according to indication, organ under examination and possibly according to patient parameters such as age, weight, BMI, etc.
- This protocol is characterized e.g. by amount of contrast agent, injection rate and start of the injection relative to the scan.
- the injection itself is then implemented by an injection device, the parameters of which are set by the protocol.
- the start point of the scan can also be determined on the basis of what is known as a bolus trigger.
- images are captured in a time sequence at a predefined position, and the scan is triggered when a predefined attenuation value (CT value, gray level) is exceeded in a defined region of the image, also known as the region of interest (ROI), e.g. in a large vessel.
- CT value predefined attenuation value
- ROI region of interest
- the injection is actually performed manually (injection using a syringe), in which case it is very likely that start of the injection, duration and amount of contrast agent will be far removed from the optimum timing and minimum amount of contrast agent. For example, there is no need to continue to inject in a time period before the scan end equal to the time between injection start and arrival of the bolus in the region of interest, because the contrast agent injected in this time period will no longer have an effect on the image (owing to its delayed arrival in the region of interest). Without further information, it is practically impossible to make an estimate from an indicator (e.g. lamp or acoustic signal) signaling the operation of the acquisition apparatus (scan in progress, e.g. using X-rays). This results in inefficient use of contrast agent and increases the risk for the patient and the costs of the examination.
- an indicator e.g. lamp or acoustic signal
- At least one embodiment of the invention defines an apparatus and/or a method for diagnostic imaging that reduces or even minimizes the risk for the patient and improves the economic efficiency.
- at least one embodiment of the invention improves or even optimizes the contrast administration where there is no assistance from special injectors or injection devices (manual contrast administration).
- At least one embodiment is directed to a method and at least one embodiment is directed to an apparatus.
- An embodiment of the invention also relates to a method for determining a point in time for outputting a signal that signals a start and/or an end of the administration of a contrast agent, and for determining a point in time for the start or the end of an operating state of a medical machine at a predefined point in time related in time to the signal.
- An embodiment of the invention also relates to a method for operating a medical machine, wherein
- An apparatus for controlling the acquisition of medical images, which apparatus comprises a unit that is designed to control, in particular to start and/or to end, a data-acquisition scan, and a signaling unit, which is coupled to said unit and is designed to output, relative in time to the data-acquisition scan, a signal for starting and/or stopping a manual contrast administration.
- An apparatus is for a medical machine (apparatus for capturing medical images), in particular of a computed tomography machine, comprising
- FIG. 1 is a diagram for illustrating the method according to an example embodiment of the invention.
- FIG. 2 shows an apparatus according to an example embodiment of the invention for capturing medical images.
- An apparatus for controlling the acquisition of medical images, which apparatus comprises a unit that is designed to control, in particular to start and/or to end, a data-acquisition scan, and a signaling unit, which is coupled to said unit and is designed to output, relative in time to the data-acquisition scan, a signal for starting and/or stopping a manual contrast administration.
- An idea of at least one embodiment of the invention is to signal the start and/or the end of a manual contrast administration (contrast agent is administered without controlled and/or automatic injector, e.g. it is administered by a standard commercial syringe) relative in time to a scan, which in particular is to be performed subsequently.
- the signaling unit may be in particular a visual, haptic and/or acoustic signaling unit, which is connected to the acquisition unit (for example CT machine) and gives instructions on the manual (non-automated) administration of contrast agent, e.g. using a syringe.
- the instruction may thus be a light signal and/or acoustic signal, for example.
- This may instruct, for instance, continuous pressing of the syringe plunger and/or stopping the injection.
- different signals can be provided for this purpose.
- the start of a signal signals the start of the contrast administration, and the end of the signal signals the end of the contrast administration.
- the contrast agent is then meant to be administered in particular precisely during the output of the e.g. visual or acoustic signal.
- the apparatus according to at least one embodiment of the invention and the method according to at least one embodiment of the invention provide considerable assistance during manual injection of contrast agent. This has a positive effect on the expected image quality, because it is possible to make better use of the contrast-enhancing effect. At the same time, it increases the safety of the patients because the amount of contrast agent is kept lower than for an injection without assistance. In environments that lack the financial means for purchasing/operating a controlled injector, for example, there is no need to compromise on patient safety.
- the signaling of the start of the manual contrast administration is timed with respect to a manual or automatic start of the acquisition process.
- the signal which instructs a start of the manual administration of contrast agent, can be triggered, for example, after a predetermined or preset time delay after switch-on of the acquisition apparatus or an activation and/or a start of the acquisition procedure.
- any point in time can be selected for signaling the start of the contrast administration. What is important is that this point in time is known so that it is possible to calculate further values therefrom, for instance the time until a bolus arrives at a region of interest, the start of the data scan or the duration of the contrast administration.
- triggering the data-acquisition scan is timed with respect to the signaled start of the manual contrast administration.
- a best possible start time for the data-acquisition scan can be chosen using the known time for the start of the contrast administration (assuming that this starts at the time of the start signal). For instance, a delay to the scan start with respect to the injection start can be set, if applicable according to further parameters such as, for example, patient size, patient weight and/or spatial relationship between injection location and ROI.
- the data acquisition starts at a predetermined time delay after the signal for starting the contrast administration.
- triggering the scan comprises a bolus triggering, i.e. initiating the process of bolus triggering (or start of a monitoring scan) is timed with respect to the signaled start of the manual contrast administration.
- the monitoring scan can be performed simultaneous to, or at a predetermined delay with respect to, signaling the start of the contrast administration.
- the point in time of signaling the end of the manual contrast administration is calculated.
- a defined injection duration can be provided.
- the end of the contrast-agent injection is then calculated on the basis of the signaled start time for the contrast-agent injection and the defined injection duration.
- the signalling of the end of the manual contrast administration is timed with respect to a characteristic time interval ⁇ T, wherein the characteristic time interval ⁇ T is a time difference between the arrival of contrast agent at a predefined position in the body (ROI) and the point in time of signaling the start of the manual contrast administration.
- the characteristic time ⁇ T is hence the time that elapses for a patient between start of the injection (assuming that the injection is started at the time of the signaling) and arrival of the contrast agent at the desired position in the body.
- the signaling of the end of the contrast administration preferably takes place at the latest at a time that lies in advance of the end of the scan by the magnitude of the time interval ⁇ T.
- the time interval ⁇ T is estimated.
- An empirical value determined from analyzing a patient collective is preferably used for the estimate. This analysis preferably additionally takes into account additional patient parameters such as size and weight, for instance.
- the time interval ⁇ T is calculated.
- the time interval ⁇ T is determined on the basis of a bolus triggering.
- the time interval ⁇ T in particular equals the difference between a time at which a defined threshold value (attenuation value, gray level, enhancement) is attained and the point in time of signaling the start of the contrast administration.
- the time interval ⁇ T is preferably calculated on the basis of a monitoring scan at the predefined position in the body.
- the arrival of a bolus in the region of interest (ROI) is detected by the monitoring scan, and therefore the time delay with respect to the start of the contrast-agent injection can be determined.
- the calculation of the time interval ⁇ T takes into account the point in time of signaling the start of the manual contrast administration.
- the time interval ⁇ T is calculated as the difference between attaining a defined threshold value (trigger) and the point in time of signaling the start of the manual contrast administration.
- the point in time of signaling the end of the manual contrast administration can be calculated on the basis of a flow model.
- the point in time of signaling the end of the manual contrast administration, or the time interval ⁇ T can be determined or calculated in particular using a hydrodynamic or pharmacokinetic flow model. This could then also take into account, for instance, the length of time for the already injected amount of contrast agent.
- the point in time of signaling the start of the contrast administration and/or the trigger signal is preferably also used.
- an advance signal is produced before signaling the start and/or end of the manual contrast administration.
- the advance signal is used in particular for eliminating, or more precisely taking into account, response times. For instance, the advance signal can be triggered a predefined time before the actual signal.
- the advance signal comprises a countdown.
- a countdown can be performed before the actual signaling (before the signal for starting and/or stopping the contrast administration), for instance a countdown using color coding (light) or frequency coding of an audio tone (acoustic signal), in order to hit the start point and/or end point of the manual injection more closely.
- the apparatus comprises a processing unit, which is designed to calculate a start time and/or an end time for the manual contrast administration.
- the processing unit is designed to calculate the end time for the manual contrast administration on the basis of a characteristic time interval ⁇ T, wherein the characteristic time interval ⁇ T is a time difference between the arrival of contrast agent (a contrast-agent bolus) at a predefined position in the body and the point in time of signaling the start of the manual contrast administration.
- a characteristic time interval ⁇ T is a time difference between the arrival of contrast agent (a contrast-agent bolus) at a predefined position in the body and the point in time of signaling the start of the manual contrast administration.
- FIG. 1 shows an example of the sequence of a diagnostic imaging process using contrast administration.
- the bottom region shows the timing diagram of a CT scan (CT).
- CT CT
- What is known as a monitoring scan 42 is performed first, which is used to trigger the actual examination scan 44 .
- images are captured in a time sequence.
- the scan 44 is triggered when a predefined threshold value 46 (signal level, gray level, attenuation value or CT value) is exceeded in a defined region of interest (ROI, e.g. a large vessel).
- ROI region of interest
- the scan 44 in this case starts at a predefined delay after the predefined threshold value 46 is attained.
- the scan 44 is started at the time T S and ends at the time T E .
- the central region of the diagram shows the signal level S (gray level, attenuation value or CT value) in the timing diagram.
- the administration of contrast agent (KM) causes the signal level S to rise and to attain a predefined threshold value at the point 46 .
- the monitoring scan 42 ends and the examination scan 44 is triggered when the threshold value 46 is attained.
- the examination scan 44 then starts with a delay after being triggered.
- the top region of the diagram shows schematically the contrast agent KM, or more precisely the injection of the contrast agent.
- the injection of a contrast-agent bolus 40 starts at the time T I,on .
- the contrast agent is preferably injected at a constant rate in this process.
- the injection ends at the time T I,off .
- the method according to an example embodiment of the invention and the apparatus according to an example embodiment of the invention are used to signal to a user the time T I,on and/or the time T I,off . Hence the user knows when he is meant to start and/or end the injection of a contrast-agent bolus.
- Initiation of the start time of the bolus triggering is timed with respect to the time T I,on (for example simultaneously or at a predetermined delay).
- the switch-off time T I,off of the signal for the contrast-agent injection can advantageously also be calculated in step 4 using hydrodynamic or pharmacokinetic flow models.
- the method can also be used without bolus triggering, with the parameter ⁇ T being estimated in this case, for example.
- the parameter ⁇ T could be set to equal ⁇ T max or ⁇ T min , which is the maximum or minimum expected arrival time length obtained from the analysis of a large patient collective. Again in this case, patient size and patient weight could be included in order to obtain a better estimate.
- the signal for manual injection can be made, for example, visually (e.g. using a lamp) and/or acoustically (signal tone).
- An enhanced indication for eliminating response times is also possible.
- a countdown can be performed e.g. from the current instant in time, which countdown, for example, can be color-coded (light) or coded in terms of the frequency of the audio tone (acoustic signal). This makes it easier for the user to hit the start point and/or end point of the manual injection more closely.
- a predefined injection duration (e.g. ten seconds) could also be set in order to assist the manual injection. This could be done, for example, by making the signal last as long as the desired injection duration.
- FIG. 2 shows an example embodiment of an apparatus 10 according to the invention for implementing the method according to the invention.
- the apparatus 10 comprises an acquisition unit 20 , which in this case is an X-ray machine, in particular a C-arm machine.
- the acquisition unit 20 comprises an X-ray source 22 and an X-ray detector 23 , which are attached to the ends of a C-arm 21 .
- the C-arm 21 can be tilted about a patient couch 25 .
- the X-ray detector 23 is preferably a digital X-ray detector, which can produce digital X-ray images of a patient 1 lying on the patient couch 25 .
- the C-arm 21 is mounted so that it can move on a stand 24 .
- the acquisition unit 20 is designed to capture two-dimensional projected images (fluoroscopy images) at short time intervals (preferably at least one image every two seconds).
- the acquisition unit 20 is controlled by a control unit 32 .
- the control unit 32 is coupled to a signaling unit 36 , which is designed to signal at least one signal for signaling the start of a manual injection of contrast agent and/or the end of such an injection.
- the signaling can be acoustic and/or visual, for example.
- the essential factor is that the injection is not controlled automatically.
- a processing unit 34 which can be part of the control unit 32 , is provided for calculating the time T I,on and/or the time T I,off (or for calculating the time interval ⁇ T).
- the processing unit 34 is designed to determine or to calculate the start time and/or the end time of the manual contrast administration.
- the signaling unit 36 is designed to output according to the start time and/or end time determined by the processing unit 34 , a user-perceptible signal for starting and/or stopping the manual contrast administration.
- Control unit 32 and signaling unit 36 can be part of a control apparatus 30 , which can also be referred to as an apparatus 30 for instructing a manual contrast administration.
- the apparatus 30 forms a separate aspect of the invention.
- the apparatus 30 is designed to signal the start and/or the end of a manual contrast administration and to control in synchronization therewith the acquisition unit 20 (start and end of a monitoring scan 42 and/or of a (examination) scan 44 ).
- a control apparatus for a medical machine (apparatus for capturing medical images), in particular of a computed tomography machine, comprising
- a medical machine in particular a computed tomography machine, comprising the control apparatus described above.
- the signal in particular may be a haptically, acoustically and/or visually perceptible signal.
- the point(s) in time for outputting the signal that signals the start and/or the end of the administration of a contrast agent can be determined as described above. Predetermined values for these point(s) in time can preferably be stored in the control apparatus.
- the point(s) in time for the start or the end of the operating state of the medical machine can be determined as described above. Predetermined values for these point(s) in time can preferably be stored in the control apparatus.
- Electronic storage for instance, can be used for storing predetermined time points.
- the operating state of the medical machine can be e.g. an operating state during which a monitoring scan or an examination scan is performed.
- Different user-selectable points in time or combinations of points in time for outputting the signal that signals the start and/or the end of the administration of a contrast agent, and for the start or the end of the operating state of the medical machine can be stored in the control apparatus for different examination protocols (e.g. depending on the region of interest (ROI), e.g. thorax, heart, predefined blood vessels), different contrast agents or different patient characteristics (e.g. male/female, weight, size, clinical condition, pulse, blood pressure, medication).
- ROI region of interest
- patient characteristics e.g. male/female, weight, size, clinical condition, pulse, blood pressure, medication.
- predetermined points in time can be adjusted according to different patient characteristics so that the points in time can be used to adapt defined intervals (e.g. the duration of an operating state) to a patient under examination.
- An embodiment of the invention also relates to a method for determining a point in time for outputting a signal that signals a start and/or an end of the administration of a contrast agent, and for determining a point in time for the start or the end of an operating state of a medical machine at a predefined point in time related in time to the signal.
- An embodiment of the invention also relates to a method for operating a medical machine, wherein
- the times for the start and/or for the end of an interval can be indicated in particular by the start or end of a signal.
- the term “signal” includes the start, the duration and the end of the signal, each taken independently.
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Abstract
Description
- This application is the national phase under 35 U.S.C. §371 of PCT International Application No. PCT/EP2015/052484 which has an International filing date of Feb. 6, 2015, which designated the United States of America and which claims priority to European patent application number EP 14156162.1 filed Feb. 21, 2014, the entire contents of which are hereby incorporated herein by reference.
- An embodiment of invention generally relates to a method and/or to an apparatus for capturing medical images, in particular via computed tomography (CT) or magnetic resonance imaging (MRI). In particular, an embodiment of the invention relates to capturing two-dimensional or three-dimensional images of the inside of a human body or of the body of an animal, which images are meant to show or display blood vessels in particular.
- It is known to inject a contrast agent in order to improve the display of blood vessels. Medical imaging using a contrast agent has the fundamental problem here of achieving contrast enhancement in vessels or tissue that is consistent over time or simultaneous with data acquisition while aiming in particular to use a minimum possible amount of contrast agent to achieve contrast enhancement. Contrast agents, like the radiation dose, have a potentially harmful effect on the patient, which is why it makes sense to keep levels to a minimum. Cost is also a factor when using a contrast agent, and therefore reducing the amount of contrast agent is also advantageous financially to organizations that operate imaging systems.
- The contrast agent is usually injected on the basis of a protocol, which is specified according to indication, organ under examination and possibly according to patient parameters such as age, weight, BMI, etc. This protocol is characterized e.g. by amount of contrast agent, injection rate and start of the injection relative to the scan. The injection itself is then implemented by an injection device, the parameters of which are set by the protocol.
- The start point of the scan can also be determined on the basis of what is known as a bolus trigger. In this case, images are captured in a time sequence at a predefined position, and the scan is triggered when a predefined attenuation value (CT value, gray level) is exceeded in a defined region of the image, also known as the region of interest (ROI), e.g. in a large vessel. This means that the scan procedure can take into account the patient-dependent time between start of the injection and arrival of the contrast agent in the region of interest in the body.
- Sometimes, however, the injection is actually performed manually (injection using a syringe), in which case it is very likely that start of the injection, duration and amount of contrast agent will be far removed from the optimum timing and minimum amount of contrast agent. For example, there is no need to continue to inject in a time period before the scan end equal to the time between injection start and arrival of the bolus in the region of interest, because the contrast agent injected in this time period will no longer have an effect on the image (owing to its delayed arrival in the region of interest). Without further information, it is practically impossible to make an estimate from an indicator (e.g. lamp or acoustic signal) signaling the operation of the acquisition apparatus (scan in progress, e.g. using X-rays). This results in inefficient use of contrast agent and increases the risk for the patient and the costs of the examination.
- At least one embodiment of the invention defines an apparatus and/or a method for diagnostic imaging that reduces or even minimizes the risk for the patient and improves the economic efficiency. In particular, at least one embodiment of the invention improves or even optimizes the contrast administration where there is no assistance from special injectors or injection devices (manual contrast administration).
- At least one embodiment is directed to a method and at least one embodiment is directed to an apparatus. The subject matter of the claims and of the following description, in particular in conjunction with the figures, contains example embodiments of the invention.
- The method according to an embodiment of the invention for capturing medical images of the human body or body of an animal comprises:
-
- (1) performing a data-acquisition scan, and
- (2) signaling the start and/or the end of a manual contrast administration relative in time to the data-acquisition scan.
- An embodiment of the invention also relates to a method for determining a point in time for outputting a signal that signals a start and/or an end of the administration of a contrast agent, and for determining a point in time for the start or the end of an operating state of a medical machine at a predefined point in time related in time to the signal.
- An embodiment of the invention also relates to a method for operating a medical machine, wherein
-
- a signaling unit signals a start and/or an end of the administration of a contrast agent,
- an operating state of the medical machine is timed to start and/or end with respect to a signal that is output by the signaling unit.
- An apparatus according to an embodiment of the invention is for capturing medical images of the human body or body of an animal comprises an acquisition unit, which is designed to perform a data-acquisition scan, and a signaling unit, which is coupled to the acquisition unit and is designed to output, relative in time to the data-acquisition scan, a signal for starting and/or stopping a manual contrast administration.
- An apparatus according to an embodiment of the invention is for controlling the acquisition of medical images, which apparatus comprises a unit that is designed to control, in particular to start and/or to end, a data-acquisition scan, and a signaling unit, which is coupled to said unit and is designed to output, relative in time to the data-acquisition scan, a signal for starting and/or stopping a manual contrast administration.
- An apparatus according to an embodiment of the invention is for a medical machine (apparatus for capturing medical images), in particular of a computed tomography machine, comprising
-
- a signaling unit, which is designed to output a signal that signals a start and/or an end of the administration of a contrast agent, and
- a unit that is designed to control the start and/or the end of an operating state of the medical machine at a predefined time related in time to a signal that is output by the signaling unit.
- The invention is described further below with reference to an example embodiment, which is depicted in the accompanying figures, in which:
-
FIG. 1 is a diagram for illustrating the method according to an example embodiment of the invention; and -
FIG. 2 shows an apparatus according to an example embodiment of the invention for capturing medical images. - The method according to an embodiment of the invention for capturing medical images of the human body or body of an animal comprises:
-
- (3) performing a data-acquisition scan, and
- (4) signaling the start and/or the end of a manual contrast administration relative in time to the data-acquisition scan.
- The apparatus according to an embodiment of the invention for capturing medical images of the human body or body of an animal comprises an acquisition unit, which is designed to perform a data-acquisition scan, and a signaling unit, which is coupled to the acquisition unit and is designed to output, relative in time to the data-acquisition scan, a signal for starting and/or stopping a manual contrast administration.
- An apparatus according to an embodiment of the invention is for controlling the acquisition of medical images, which apparatus comprises a unit that is designed to control, in particular to start and/or to end, a data-acquisition scan, and a signaling unit, which is coupled to said unit and is designed to output, relative in time to the data-acquisition scan, a signal for starting and/or stopping a manual contrast administration.
- An idea of at least one embodiment of the invention is to signal the start and/or the end of a manual contrast administration (contrast agent is administered without controlled and/or automatic injector, e.g. it is administered by a standard commercial syringe) relative in time to a scan, which in particular is to be performed subsequently. The signaling unit may be in particular a visual, haptic and/or acoustic signaling unit, which is connected to the acquisition unit (for example CT machine) and gives instructions on the manual (non-automated) administration of contrast agent, e.g. using a syringe. The instruction may thus be a light signal and/or acoustic signal, for example. This may instruct, for instance, continuous pressing of the syringe plunger and/or stopping the injection. In particular, different signals can be provided for this purpose. It is also possible that the start of a signal signals the start of the contrast administration, and the end of the signal signals the end of the contrast administration. Thus the contrast agent is then meant to be administered in particular precisely during the output of the e.g. visual or acoustic signal.
- The apparatus according to at least one embodiment of the invention and the method according to at least one embodiment of the invention provide considerable assistance during manual injection of contrast agent. This has a positive effect on the expected image quality, because it is possible to make better use of the contrast-enhancing effect. At the same time, it increases the safety of the patients because the amount of contrast agent is kept lower than for an injection without assistance. In environments that lack the financial means for purchasing/operating a controlled injector, for example, there is no need to compromise on patient safety.
- In an example embodiment of the method, the signaling of the start of the manual contrast administration is timed with respect to a manual or automatic start of the acquisition process.
- The signal, which instructs a start of the manual administration of contrast agent, can be triggered, for example, after a predetermined or preset time delay after switch-on of the acquisition apparatus or an activation and/or a start of the acquisition procedure. In principle, any point in time can be selected for signaling the start of the contrast administration. What is important is that this point in time is known so that it is possible to calculate further values therefrom, for instance the time until a bolus arrives at a region of interest, the start of the data scan or the duration of the contrast administration.
- In another example embodiment of the invention, triggering the data-acquisition scan is timed with respect to the signaled start of the manual contrast administration.
- A best possible start time for the data-acquisition scan can be chosen using the known time for the start of the contrast administration (assuming that this starts at the time of the start signal). For instance, a delay to the scan start with respect to the injection start can be set, if applicable according to further parameters such as, for example, patient size, patient weight and/or spatial relationship between injection location and ROI. Thus the data acquisition starts at a predetermined time delay after the signal for starting the contrast administration. It is also possible that triggering the scan comprises a bolus triggering, i.e. initiating the process of bolus triggering (or start of a monitoring scan) is timed with respect to the signaled start of the manual contrast administration. For example, the monitoring scan can be performed simultaneous to, or at a predetermined delay with respect to, signaling the start of the contrast administration.
- In another example embodiment, the point in time of signaling the end of the manual contrast administration is calculated.
- For example, a defined injection duration can be provided. The end of the contrast-agent injection is then calculated on the basis of the signaled start time for the contrast-agent injection and the defined injection duration.
- In another example embodiment, the signalling of the end of the manual contrast administration is timed with respect to a characteristic time interval ΔT, wherein the characteristic time interval ΔT is a time difference between the arrival of contrast agent at a predefined position in the body (ROI) and the point in time of signaling the start of the manual contrast administration.
- The characteristic time ΔT is hence the time that elapses for a patient between start of the injection (assuming that the injection is started at the time of the signaling) and arrival of the contrast agent at the desired position in the body. The signaling of the end of the contrast administration preferably takes place at the latest at a time that lies in advance of the end of the scan by the magnitude of the time interval ΔT.
- In an example embodiment, the time interval ΔT is estimated. An empirical value determined from analyzing a patient collective is preferably used for the estimate. This analysis preferably additionally takes into account additional patient parameters such as size and weight, for instance.
- In an alternative embodiment, the time interval ΔT is calculated. In particular, it is preferred that the time interval ΔT is determined on the basis of a bolus triggering. In this case, the time interval ΔT in particular equals the difference between a time at which a defined threshold value (attenuation value, gray level, enhancement) is attained and the point in time of signaling the start of the contrast administration.
- Thus the time interval ΔT is preferably calculated on the basis of a monitoring scan at the predefined position in the body. The arrival of a bolus in the region of interest (ROI) is detected by the monitoring scan, and therefore the time delay with respect to the start of the contrast-agent injection can be determined.
- In another example embodiment of the method according to the invention, the calculation of the time interval ΔT takes into account the point in time of signaling the start of the manual contrast administration.
- More preferably, the time interval ΔT is calculated as the difference between attaining a defined threshold value (trigger) and the point in time of signaling the start of the manual contrast administration.
- Alternatively or additionally, the point in time of signaling the end of the manual contrast administration can be calculated on the basis of a flow model.
- The point in time of signaling the end of the manual contrast administration, or the time interval ΔT, can be determined or calculated in particular using a hydrodynamic or pharmacokinetic flow model. This could then also take into account, for instance, the length of time for the already injected amount of contrast agent. In addition, the point in time of signaling the start of the contrast administration and/or the trigger signal (attaining a defined threshold value) is preferably also used.
- In another example embodiment of the invention, an advance signal is produced before signaling the start and/or end of the manual contrast administration. The advance signal is used in particular for eliminating, or more precisely taking into account, response times. For instance, the advance signal can be triggered a predefined time before the actual signal.
- In an example embodiment, the advance signal comprises a countdown. For example, a countdown can be performed before the actual signaling (before the signal for starting and/or stopping the contrast administration), for instance a countdown using color coding (light) or frequency coding of an audio tone (acoustic signal), in order to hit the start point and/or end point of the manual injection more closely.
- In terms of the apparatus, in an example embodiment of the invention, the apparatus comprises a processing unit, which is designed to calculate a start time and/or an end time for the manual contrast administration.
- In an example embodiment of the invention, the processing unit is designed to calculate the end time for the manual contrast administration on the basis of a characteristic time interval ΔT, wherein the characteristic time interval ΔT is a time difference between the arrival of contrast agent (a contrast-agent bolus) at a predefined position in the body and the point in time of signaling the start of the manual contrast administration.
-
FIG. 1 shows an example of the sequence of a diagnostic imaging process using contrast administration. The bottom region shows the timing diagram of a CT scan (CT). What is known as amonitoring scan 42 is performed first, which is used to trigger theactual examination scan 44. In this scan, images are captured in a time sequence. Thescan 44 is triggered when a predefined threshold value 46 (signal level, gray level, attenuation value or CT value) is exceeded in a defined region of interest (ROI, e.g. a large vessel). Thescan 44 in this case starts at a predefined delay after thepredefined threshold value 46 is attained. Thescan 44 is started at the time TS and ends at the time TE. - The central region of the diagram shows the signal level S (gray level, attenuation value or CT value) in the timing diagram. The administration of contrast agent (KM) causes the signal level S to rise and to attain a predefined threshold value at the
point 46. Themonitoring scan 42 ends and theexamination scan 44 is triggered when thethreshold value 46 is attained. The examination scan 44 then starts with a delay after being triggered. - The top region of the diagram shows schematically the contrast agent KM, or more precisely the injection of the contrast agent. The injection of a contrast-
agent bolus 40 starts at the time TI,on. The contrast agent is preferably injected at a constant rate in this process. The injection ends at the time TI,off. - The method according to an example embodiment of the invention and the apparatus according to an example embodiment of the invention are used to signal to a user the time TI,on and/or the time TI,off. Hence the user knows when he is meant to start and/or end the injection of a contrast-agent bolus.
- The method according to an example embodiment of the invention in particular contains the following steps:
-
- 1. (Manually) activating the signal for instructing the start of the manual injection. The start of the injection TI,on is signaled at a certain delay after the, possibly manual, activation. In principle, any point in time can be selected for the time TI,on, which preferably lies at a certain time interval after the switch-on and/or activation of the signal and/or of the apparatus. Signaling the start time of the injection is used in particular for activating the
monitoring scan 42 and/or thescan 44 on the basis of this time. - 2. Starting a bolus triggering or a monitoring scan, i.e.
- 1. (Manually) activating the signal for instructing the start of the manual injection. The start of the injection TI,on is signaled at a certain delay after the, possibly manual, activation. In principle, any point in time can be selected for the time TI,on, which preferably lies at a certain time interval after the switch-on and/or activation of the signal and/or of the apparatus. Signaling the start time of the injection is used in particular for activating the
- periodic sequence of scans at a predefined, sensible position in the body, and measurement of the signal levels (CT values) inside an ROI. Initiation of the start time of the bolus triggering is timed with respect to the time TI,on (for example simultaneously or at a predetermined delay).
-
- 3. On a defined
threshold value 46 being attained (trigger):- a) triggering the
scan 44, preferably at a predefined delay, and - b) calculating a characteristic time ΔT, which elapses for this patient between start of the injection and arrival of the contrast agent at the desired position in the body. The time interval between injection start (TI,on) and attainment of the threshold value 46 (TT) can be set as a conservative estimate for ΔT.
- a) triggering the
- 4. Calculating a time at which the injection can be stopped (TI,off), e.g. as TI,off=TE−ΔT, where TE denotes the end of the scan (=end of the radiation). Alternatively, the defined stop of the injection could also be calculated as TI,off=TS−ΔT, where TS denotes the start of the scan (=start of the radiation).
- 5. Deactivating the signal at TI,off, but at the latest at TE−ΔTmin, where ΔTmin is a sensible minimum time length for arrival of the contrast agent, which time length has been predefined e.g. from the analysis of a large patient collective.
- 6. Stopping the scan at TE.
- 3. On a defined
- The switch-off time TI,off of the signal for the contrast-agent injection can advantageously also be calculated in step 4 using hydrodynamic or pharmacokinetic flow models.
- These could then also take into account, for instance, the length of time for the already injected amount of contrast agent, and the trigger signal. This applies likewise to defining an optimum parameter ΔT (see step 3).
- The method can also be used without bolus triggering, with the parameter ΔT being estimated in this case, for example. In the simplest case, it could be set to equal ΔTmax or ΔTmin, which is the maximum or minimum expected arrival time length obtained from the analysis of a large patient collective. Again in this case, patient size and patient weight could be included in order to obtain a better estimate.
- The signal for manual injection can be made, for example, visually (e.g. using a lamp) and/or acoustically (signal tone). An enhanced indication for eliminating response times is also possible. After calculating TI,off, a countdown can be performed e.g. from the current instant in time, which countdown, for example, can be color-coded (light) or coded in terms of the frequency of the audio tone (acoustic signal). This makes it easier for the user to hit the start point and/or end point of the manual injection more closely.
- As an alternative to an injection stop based on the parameter ΔT, a predefined injection duration (e.g. ten seconds) could also be set in order to assist the manual injection. This could be done, for example, by making the signal last as long as the desired injection duration.
-
FIG. 2 shows an example embodiment of anapparatus 10 according to the invention for implementing the method according to the invention. Theapparatus 10 comprises anacquisition unit 20, which in this case is an X-ray machine, in particular a C-arm machine. Theacquisition unit 20 comprises anX-ray source 22 and anX-ray detector 23, which are attached to the ends of a C-arm 21. The C-arm 21 can be tilted about apatient couch 25. TheX-ray detector 23 is preferably a digital X-ray detector, which can produce digital X-ray images of a patient 1 lying on thepatient couch 25. The C-arm 21 is mounted so that it can move on astand 24. - The
acquisition unit 20 is designed to capture two-dimensional projected images (fluoroscopy images) at short time intervals (preferably at least one image every two seconds). Theacquisition unit 20 is controlled by acontrol unit 32. Thecontrol unit 32 is coupled to asignaling unit 36, which is designed to signal at least one signal for signaling the start of a manual injection of contrast agent and/or the end of such an injection. The signaling can be acoustic and/or visual, for example. The essential factor is that the injection is not controlled automatically. - A
processing unit 34, which can be part of thecontrol unit 32, is provided for calculating the time TI,on and/or the time TI,off (or for calculating the time interval ΔT). Theprocessing unit 34 is designed to determine or to calculate the start time and/or the end time of the manual contrast administration. The signalingunit 36 is designed to output according to the start time and/or end time determined by theprocessing unit 34, a user-perceptible signal for starting and/or stopping the manual contrast administration. -
Control unit 32 andsignaling unit 36 can be part of acontrol apparatus 30, which can also be referred to as anapparatus 30 for instructing a manual contrast administration. Theapparatus 30 forms a separate aspect of the invention. Theapparatus 30 is designed to signal the start and/or the end of a manual contrast administration and to control in synchronization therewith the acquisition unit 20 (start and end of amonitoring scan 42 and/or of a (examination) scan 44). - An example embodiment of the invention can also be described in particular as follows:
- A control apparatus for a medical machine (apparatus for capturing medical images), in particular of a computed tomography machine, comprising
-
- a signaling unit, which is designed to output a signal that signals a start and/or an end of the administration of a contrast agent, and
- a unit that is designed to control the start and/or the end of an operating state of the medical machine at a predefined time related in time to a signal that is output by the signaling unit.
- A medical machine, in particular a computed tomography machine, comprising the control apparatus described above.
- The signal in particular may be a haptically, acoustically and/or visually perceptible signal.
- The point(s) in time for outputting the signal that signals the start and/or the end of the administration of a contrast agent can be determined as described above. Predetermined values for these point(s) in time can preferably be stored in the control apparatus.
- The point(s) in time for the start or the end of the operating state of the medical machine can be determined as described above. Predetermined values for these point(s) in time can preferably be stored in the control apparatus.
- Electronic storage, for instance, can be used for storing predetermined time points.
- The operating state of the medical machine can be e.g. an operating state during which a monitoring scan or an examination scan is performed.
- Different user-selectable points in time or combinations of points in time for outputting the signal that signals the start and/or the end of the administration of a contrast agent, and for the start or the end of the operating state of the medical machine, can be stored in the control apparatus for different examination protocols (e.g. depending on the region of interest (ROI), e.g. thorax, heart, predefined blood vessels), different contrast agents or different patient characteristics (e.g. male/female, weight, size, clinical condition, pulse, blood pressure, medication).
- Alternatively, predetermined points in time can be adjusted according to different patient characteristics so that the points in time can be used to adapt defined intervals (e.g. the duration of an operating state) to a patient under examination.
- An embodiment of the invention also relates to a method for determining a point in time for outputting a signal that signals a start and/or an end of the administration of a contrast agent, and for determining a point in time for the start or the end of an operating state of a medical machine at a predefined point in time related in time to the signal.
- An embodiment of the invention also relates to a method for operating a medical machine, wherein
-
- a signaling unit signals a start and/or an end of the administration of a contrast agent,
- an operating state of the medical machine is timed to start and/or end with respect to a signal that is output by the signaling unit.
- The times for the start and/or for the end of an interval can be indicated in particular by the start or end of a signal. In this respect, the term “signal” includes the start, the duration and the end of the signal, each taken independently.
- Although the invention has been illustrated and described in greater detail using an example embodiment, the invention is not limited by the disclosed examples, and a person skilled in the art can derive therefrom other variants that are still covered by the scope of protection of the invention.
Claims (37)
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JP2015223233A (en) * | 2014-05-26 | 2015-12-14 | 株式会社東芝 | Contrast medium injection support device and x-ray photographing device |
US20170316562A1 (en) * | 2016-04-28 | 2017-11-02 | Siemens Healthcare Gmbh | Determining at least one protocol parameter for a contrast agent-assisted imaging method |
CN111544019A (en) * | 2020-04-10 | 2020-08-18 | 北京东软医疗设备有限公司 | Method, device and system for determining contrast agent injection time |
DE102020212335A1 (en) | 2020-09-30 | 2022-03-31 | Siemens Healthcare Gmbh | Method for controlling an imaging device for acquiring a contrast agent-enhanced image data set |
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WO2015124441A1 (en) | 2015-08-27 |
US11857356B2 (en) | 2024-01-02 |
CN106061390A (en) | 2016-10-26 |
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